Response to: “Comment to On-demand use of peripheral arterial catheters outside the Intensive Care Unit: Development and retrospective evaluation of an internal protocol for insertion and management”

Dear Editor

We have read the article by Elli et al., “Comment to On-demand use of peripheral arterial catheters outside the Intensive Care Unit: Development and retrospective evaluation of an internal protocol for insertion and management.”

We would like to reply with three points: first of all, thanking the Authors for the positive reception of our manuscript.

Secondly, we totally agree with the need for evaluation of ulnar compensation. We believe that safety should be imperative and any type of maneuver that increases the level should be carried out.

It is true that in literature there are also opposing opinions ¹ and that the Society for Cardiovascular Angiography and Interventions (SCAI) does not recommend performing a collateral test before a cardiac procedure using a trans-radial approach, ² but it is also true that the setting and priority are different: the Radialists use larger devices with short indwelling times, massive anticoagulation and, above all, have as their main objective the recanalization of the occluded coronary vessels, using a more secure technique than the femoral approach.

For Vascular Access Specialists is different: they place devices that are on-site for several days, their patients receive lower dosage of antithrombotic therapy than those undergoing coronary procedures, and the commitment to guarantee the preservation of vessels is part of their formation. On the other hand, in a coronary procedure, the main objective is the heart, in a procedure for radial artery catheter insertion, the main objective is the radial artery itself, almost the same procedure but the focus is different

Third, but not least, it is extremely interesting to read that almost 10% of patients evaluated, present an occasional finding of radial artery thrombosis. The use by Authors of the reverse Barbeau test to observe this eventuality, suggests that often palpation of the pulse wave at the wrist may not be sufficient to evaluate the patency of radial artery. And that in case of puncture with blind technique, a test that prevents insertion in thrombotic vessel (in this case the reverse Barbeau test) could be a game-changer.

We are pleased that within this commentary article, there are two interesting ideas for reflection about some aspects of radial artery catheterization, a procedure so used but, in some aspects still so unexplored.